Family Nurse Practitioner

What is a family nurse practitioner?

A family nurse practitioner (FNP) is a highly trained nursing professional that has demonstrated advanced clinical knowledge and is qualified to be a first-contact or direct care provider. An FNP may be a registered nurse with a Master of Science or other advanced degree in nursing who has selected a specialty, completed a rigorous clinical rotation, passed a national examination, and received the appropriate license from his or her state of residence.

How is a family nurse practitioner different from other nurses?

There are many types of nurses with varying degrees of education and training. A licensed vocational/practical nurse (LPN or LVN) has one to two years of education and may only have an associate’s degree. Registered nurses (RN) may have an associate’s or bachelor’s degree, and have typically completed a two-year education program.

The advanced education and thorough clinical training an FNP graduate receives allows them to work and deliver care much more independently than either an LVN or an RN. LVN’s work under the general supervision of a registered nurse. Registered nurses work more independently than LVN’s, but still work under the direction of a physician. RN’s can deliver care, but they are generally not in a position to direct it.

In contrast, family nurse practitioners typically work collaboratively with doctors, and in most states they are licensed to order tests and prescribe medication and other treatments. A family nurse practitioner directs the care that his or her patient receives, and in some cases the patient may have no need to see a doctor at all unless their condition is complicated enough that it should be referred to an MD specialist.

Are there different types of nurse practitioners?

Yes. There are several types of advanced practice nurses, including nurse practitioners, nurse anesthetists, nurse midwives and clinical nurse specialists. These are all areas where a nurse completes specific educational requirements and then passes a national examination to receive his or her advanced practice family nurse practitioner certification.

Within the category of “nurse practitioner” there are several sub-specialties, including family nurse practitioner. Other specialty areas include acute care, adult emphasis, several pediatric specialties, psychiatric and mental health, gerontology and diabetes management.

A family nurse practitioner studies aspects of health, wellness, illness and injury management for a full array of ages and conditions. An FNP is prepared to manage the care of patients both young and old, and takes special consideration to the relationships between patient and caregivers. FNP’s are considered generalists, meaning they have a broad knowledge base to offer care to a very broad demographic.

What does a family nurse practitioner do?

More and more, FNP’s are becoming first-contact providers. This means that when someone goes to a doctor’s office for a visit, they may actually be seeing the family nurse practitioner first. The education and training an FNP receives qualifies them to treat many conditions and make decisions with regard to the appropriate treatments, tests or medications a patient may need. A case will be referred to a physician or specialist if it is complicated or resistant to normal treatments, but it is possible that an FNP will direct the care from start to finish.

In addition to being extremely qualified care providers, the philosophy of nurse practitioners is to create a framework of overall health. This includes treating illness and injury, but also involves teaching a positive approach to prevention, wellness and a healthy lifestyle. While an FNP may be the first clinical contact for someone who needs medical attention, the FNP’s overall approach to health care delivery includes a holistic approach to maintaining health and wellness in the long term. This means that an FNP may spend equal time treating a condition and providing education by being an advocate for preventive care and general health and wellness.

Do family nurse practitioners work directly with doctors?

In some states a collaborative or supervisory relationship with a doctor is required. In other states the FNP may work more independently. While national standards in the accreditation and certification of FNPs means that most family nurse practitioner programs will create graduates of equal quality, specific guidelines for what an FNP can do – or their “scope of practice” – is determined by each state. States vary in the amount of independence that an FNP is allowed to have, so make sure that you are familiar with the guidelines that your state’s licensing board establishes.

What sorts of settings do family nurse practitioners work in?

There are many settings where family nurse practitioners might work, from freestanding clinics to hospitals.

It is very common to find a family nurse practitioner working in a physician’s office as part of a team that creates a successful family practice. An FNP may see patients in the office, or visit patients in hospital on physician’s behalf. A family nurse practitioner might work in a public health clinic helping care for patients who need access to health care despite having limited access to insurance. FNP’s might also work for insurance companies as part of wellness education programs, or providing claims oversight.

As health care demands increase, and provider shortages continue to be a problem, the skill and training of family nurse practitioners continues to open doors in all health care settings.

What is the average salary of a family nurse practitioner?

According to the U.S. Bureau of Labor Statistics (BLS), the mean annual wages for nurse practitioners (NPs) in the U.S. were $97,990 as of May 2014 data. This is much higher than the mean annual wages of $47,600 for all occupations combined in the U.S., according to May 2014 BLS data. Pay does vary based on a number of factors including time on the job, variety of experiences and even location of employment. In fact, the BLS reports that the following five states had the highest mean annual wages for nurse practitioners in the U.S. as of May 2014:

Hawaii: $115,870

Alaska: $115,670

California: $115,460

Oregon: $111,160

Massachusetts: $107,230

Is there room for advancement in the field?

The BLS shows that the best job opportunities for nurse practitioners could be available to those willing to work in underserved or rural areas. While opportunities for advancement will naturally occur as a result of other NPs retiring from the job, NPs also could find advanced job opportunities by seeking certification, such as in adult or family care. Certification can be sought through organizations such as the American Nurses Credentialing Center or the Pediatric Nursing Certification Board and shows that NPs have gone through a rigorous testing process and met specific qualifications to reach the certified level.

NPs also can specialize in a wide range of health care fields, varying from pediatric to adult-gerontology care. The specific fields are diverse, and nurses usually specialize at the master's degree level. The most recent salary information from the American Academy of Nurse Practitioners (AANP) shows, however, that out of the various fields, NPs specializing in acute care are among the highest paid. This may suggest that this could be the best NP field as far as potential for salary advancement.

Are family nurse practitioners in high demand?

Job opportunities for nurse practitioners are expected to grow by 34 percent from 2012 to 2022, according to the BLS. This much-faster-than-average-growth could lead to 37,100 new positions becoming available during this time. Driving demand should be an aging elderly population that is striving to stay healthier longer and will be in need of more health care services. Also, federal law has expanded health care coverage, meaning that more people will seek access to services ranging from preventative care to actual treatment of conditions. States are also changing laws regarding the services that nurse practitioners and other advanced practice registered nurses can provide, meaning that they may become a good source for providing primary care in the country, particularly given the reported U.S. doctor shortage.

Do family nurse practitioners bill insurance companies?

Yes. Unlike the services provided by a licensed vocational nurse or registered nurse, the services of a family nurse practitioner are considered direct care, and Medicare, Medicaid and many private insurance companies reimburse them directly.

In larger hospitals, services are bundled together and family nurse practitioners may or may not bill their services independently. However, those holding family nurse practitioner jobs in clinics of physician practices will find their services can be billed just like a doctor's can. This also means that in states where a supervisory or collaborative relationship with a doctor is not required, family nurse practitioners could establish private practices where they bill their care directly to insurance companies.

Do I need to attend an accredited school to become a family nurse practitioner?

The American Nurses Credentialing Center requires attendance at an accredited program in order to be eligible to take the national certification examination. The agencies that accredit family nurse practitioner programs are the National League for Nursing Accreditation Commission (NLNAC) and the Commission for Collegiate Nursing Education (CCNE). Additionally, in order to become licensed in your state of residence, the program must be approved by your state’s Board of Nursing. Being state approved and being accredited by the NLNAC or CCNE are not the same thing, so make sure that the program you select meets both of these requirements.

Do all nursing programs train nurses to become family nurse practitioners?

Not all programs offer master’s or doctoral degrees. Programs through local community colleges will typically not offer programs beyond practical or associate’s level educations, and four-year universities may offer bachelor’s degrees but not have master’s programs.

What if I already have a nursing degree?

There are programs that are oriented both towards students entering the profession with no nursing background, and students who are building on an earlier nursing degree. Often described as bridge programs, a nursing program that is structured around a student who already has an associate’s or bachelor’s degrees develops a curriculum that advances education that has already been completed so as to minimize duplication.

Are there schools that offer accelerated family nurse practitioner programs?

For individuals who want to pursue careers as FNPs and who already have baccalaureate degrees, there are accelerated MSN programs. Existing degrees held by would-be FNPs don’t necessarily have to be in nursing in order to meet eligibility requirements for accelerated programs, but if the bachelor’s degree is in a non-science or allied health field, there will likely be some pre-requisites in the area of biology, anatomy and physiology that need to be completed.

The accelerated degrees fit four years worth of bachelor’s and master’s degree nursing-specific education into three years. These programs are very aggressively paced, and they often schedule classes year-round. They include the same high quality coursework and demanding clinical rotations that a regular program does.

Are there schools that offer full family nurse practitioner programs available online?

Yes. For individuals who already have a bachelor’s degree, there are online programs where the coursework, examinations and homework are offered through web-based platforms. Accelerated versions of online programs are also available, and these maintain the same condensed coursework schedules as the traditional campus-based programs do. Online accelerated programs are most often scheduled, while some other online programs may allow a student to self-pace. Due to the demanding coursework and the sheer volume of information that must be taught, tested and built upon, the online accelerated programs often set a schedule that the student must keep pace with.

Clinical contact hour requirements are the same in an online program as they are in a campus-based program. Most online programs will have a coordinator available to help students find local medical facilities in which they can meet their practical contact requirements through clinical exposure to family nurse practitioner jobs.

What sort of education do I need to become a family nurse practitioner?

A family nurse practitioner needs to have a master’s or doctoral degree in nursing from a program that offers preparation for the family nurse practitioner specialty. While most master’s programs are oriented towards the eventual completion of a nurse practitioner specialty, there are programs that offer the Master of Science in nursing (MSN) with an orientation toward being a nurse educator or administrator.

How long does it take to become a family nurse practitioner?

Those starting straight out of high school with the goal of becoming a family nurse practitioner will spend six or seven years on their education and clinical training. This includes the completion of a bachelor’s and master’s degree. A full education includes general education requirements specific to the respective family nurse practitioner schools, so there is time spent in studies away

Do I need to complete my education all at once?

It is not uncommon for students to work their way up the nursing ladder, so to speak, and become a nurse practitioner in smaller increments. Student could complete courses of study to become LPN/LVNs and then start working, furthering their nursing education while they work in the field. LPNs could get their bachelor’s degrees in nursing and become RNs, then continue working towards their family nurse practitioner certification while employed as RNs.

While this does prolong the education process, it allows a nurse to earn an income while getting a more advanced degree. It also gives an FNP candidate valuable work experience, and in some cases existing work settings can be used to complete clinical hour requirements.

If a student with an LVN or RN level education is interested in becoming an FNP, there are specialty programs designed to make this happen without duplication in education or clinical training. Sometimes called “bridge” programs, these programs are crafted to build on existing coursework to advance knowledge, not repeat it.

What sort of courses would I take to become a family nurse practitioner?

The coursework in an FNP program is geared towards creating an exceptionally well-qualified nursing professional. Courses are challenging, and many include lab-work to teach beyond textbooks. FNP programs should also ensure that the population specialty coursework required by the American Nurses Credentialing Center (ANCC) is incorporated into the curriculum.

Core courses in anatomy, physiology, pharmacology and health care principles will be included in the FNP program for a student newly entering the field, or will be built on for students who already have nursing degrees. Many classes in an FNP program are progressive and build on earlier coursework. Assessment courses, for instance, advance throughout the curriculum, as do theory and practice courses.

Classes in a family nurse practitioner program may include:

Advanced health assessment

Legal and ethical considerations in nursing care

Principles in primary care

Pharmacology

Geriatric medicine

Pediatric medicine

Community health principles

Advanced nursing theory

When do I declare my family nurse practitioner specialty?

If you’ve decided that family nurse practitioner is the specialty for you, you’ll want to declare that in your nurse practitioner program soon. The agency that certifies family nurse practitioners, the ANCC, requires that a number of courses specific to the specialty you’ll be testing in be taken, so you want to make sure that you have time to include those in your course schedule. Also, provisions will be made to make sure that your clinical hours include a heavy percentage of time spent gaining exposure to family nurse practitioner jobs.

Can I take family nurse practitioner classes online?

Many nursing programs are including web-based coursework for their students since this creates more flexibility and helps eliminate travel to and from the campus, which can be a challenge for students who are working or who have families. Courses are just as challenging when provided online, as the curriculum standards are set quite high to create skilled clinicians. There are also some learning institutions that offer their entire curriculum online for students who already have baccalaureate degrees in other fields.

Is there practical training in a family nurse practitioner program?

Nursing is a hands-on profession. While a tremendous amount of information can be learned in lectures, labs and from books, the application of that knowledge always takes the form of working with actual patients in a clinical setting. Family nurse practitioner programs establish very thorough clinical rotations for their students. Additionally, the ANCC sets a 500 clinical hour requirement in order to be eligible to sit for the national examinations.

Do all family nurse practitioners have the same sort of job description?

It is somewhat of a challenge to describe the job of a family nurse practitioner, because it will vary considerably based on the state you live in, and the setting where you work.

A family nurse practitioner can work in a physician’s office or a freestanding clinic. Clinics can be either privately owned or public. A family nurse practitioner may work in a hospital or do rounds in skilled nursing facilities. An FNP may also work for a hospice or home health agency. Because of the variety in the work settings, the family nurse practitioner job description can be quite varied.

What are the typical responsibilities for a family nurse practitioner?

What does an average workday look like for a family nurse practitioner?

In general, the FNP will spend the day seeing patients, but how those visits are organized depends largely on the work setting.

An FNP who works in a family practice setting with physicians and other FNP’s will generally have a day of scheduled office visits. The same is true for the FNP who works in any type of freestanding clinic. FNP’s who are part of family practice clinics may also complete rounds on patients in skilled nursing facilities. FNP’s may visit patients who are hospitalized, or consult when a patient is being referred to a specialist or therapist. Workdays in these types of settings will include time to complete documentation, as good record keeping is essential to managing a patient’s health.

A family nurse practitioner who is part of a hospital team may see patients by completing hospital rounds and assisting floor nurses and other hospital staff by directing care or reporting to the attending physicians. Again, documentation is an essential component of the job as medical records are the means by which health care professionals share information with each other. Specific courses offered through family nurse practitioner schools address this vital component.

There are FNP’s who work in hospice and home-health agencies, and these practitioners travel during the day to patients’ homes. Seeing a patient in their home setting; however, gives a very accurate impression of the patient’s status, including how well care is being managed in the home. This gives the FNP an excellent opportunity to provide education on good practices, and teach both the patient and his or her caregivers the best techniques.

Do family nurse practitioners participate in health and wellness?

The nurse practitioner’s professional commitment to health and wellness makes them especially well qualified to advocate for a patient’s overall health maintenance, and for an NP who has pursued specialized training in family practice, this creates opportunities to educate patients in all stages of life, and across many types of health care settings.

An FNP may promote health and health education in a patient visit, or they may be part of a large program of education and advocacy for certain conditions and illnesses within a given population as part of a health fair or a corporate wellness program. An FNP who works for an insurance carrier may participate in company initiatives to provide information to its members. Or an FNP may even champion a patient who is struggling to navigate the health care system.

What’s the first step to becoming a family nurse practitioner?

Have you always wanted to help people? Does the field of health care interest you? Then this career might be right for you. But given the amount of time and energy you will invest in your education, it’s important to know if it’s a good fit.

Volunteering at local health care facilities or medical centers will give you a good idea what the job responsibilities of a nurse are, but you will want to make sure that you gain a clear understanding of specifically what a family nurse practitioners does. Because a floor

What credentials do I need?

In order to be an FNP, you must have a master’s or doctoral degree from a qualified nursing program, have family nurse practitioner certification from the American Nurses Credentialing Center (ANCC) or other certification agency, and be licensed by your state of residence.

How do I become certified as a family nurse practitioner?

The ANCC certification process involves meeting the educational criteria necessary to be eligible to sit for the national certification examination, and then passing the examination itself. To be eligible to sit for the examination, you must:

Be a licensed RN in your state of residence

Hold a master’s or doctoral degree from a family nurse practitioner school accredited by the National League for Nursing Accreditation Commission (NLNAC) or the Commission for Collegiate Nursing Education (CCNE)

Once these requirements are demonstrated, a candidate can schedule the examination. The exam is computer based. The ANCC offers classes and study groups to help a candidate prepare for the test.

How do I get my nursing license?

Licenses are issued by the Board of Nursing in each state (specific department names vary). All states in the US require a practicing FNP to have a license. Most states require that a candidate attend a Board approved nursing program and hold certification issued by the ANCC. The licensure process typically involves applications and proof of eligibility, and may involve fingerprinting and background checks.

It is important to note that some state requirements may differ from those established by the ANCC. For example, some states may require education in ethics; some may have more demanding clinical hour requirements. Most family nurse practitioner programswill ensure that graduates meet both the ANCC and state of residence requirements.

What is the difference between certification and licensing?

Certification ensures that a candidate possesses a standardized body of knowledge. Family nurse practitioners have broad responsibilities with regard to their patients’ care and passing the certification exam ensures that FNP’s possess the knowledge and skills that their profession will demand of them.

Licenses are issued by each state, as each state establishes exactly what a health care professional can and cannot do. Licensure demonstrates to the state’s population that an FNP holds the proper certification and knows what his or her scope of practice is.

How many national exams do I need to pass in the course of becoming an FNP?

In order to become a family nurse practitioner, a candidate must pass two national examinations.

The ANCC requires that a certification applicant already possess the title Registered Nurse, which includes passing the National Clinical License Examination (or, NCLEX). Then, there’s the ANCC certification exam for family nurse practitioners. Once this examination has been passed, the candidate holds the title FNP-BC, or Family Nurse Practitioner – Board Certified.

The family nurse practitioner schools, colleges, and universities below offer some of the best training available to medical degree seeking individuals. Request information from multiple registered nurse practitioner schools in order to compare programs and find the best degree for you.

Sources:

May 2014 National Occupational Employment and Wage Estimates United States, Occupational Employment Statistics, May 2014. http://www.bls.gov/oes/current/oes_nat.htm